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add documentation on _2023RVR nssp signals
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minhkhul committed Nov 17, 2024
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[The National Syndromic Surveillance Program (NSSP)](https://www.cdc.gov/nssp/php/about/index.html) is an effort to track epidemiologically relevant conditions.
This dataset in particular tracks emergency department (ED) visits arising from a subset of influenza-like illnesses, specifically influenza, COVID-19, and respiratory syncytial virus (RSV).
It is derived from the CDC's [Respiratory Virus Response NSSP Emergency Department Visit Trajectories dataset](https://data.cdc.gov/Public-Health-Surveillance/2023-Respiratory-Virus-Response-NSSP-Emergency-Dep/rdmq-nq56/about_data), which started reporting data in late 2022.
As of May 2024, NSSP received data from 78% of US EDs.
Each signal below is derived from one of two following datasets:
- Primary: [NSSP Emergency Department Visit Trajectories by State and Sub State Regions- COVID-19, Flu, RSV, Combined dataset](https://data.cdc.gov/Public-Health-Surveillance/2023-Respiratory-Virus-Response-NSSP-Emergency-Dep/rdmq-nq56/about_data)
- Secondary: [2023 Respiratory Virus Response - NSSP Emergency Department Visit Trajectories by State- COVID-19, Flu, RSV, Combined](https://data.cdc.gov/Public-Health-Surveillance/2023-Respiratory-Virus-Response-NSSP-Emergency-Dep/7mra-9cq9/data_preview) (`_2023RVR`)

Signals derived from the secondary dataset have suffix `_2023RVR` in their signal names, while signals derived from the primary dataset do not.

Both datasets started reporting data in late 2022. As of May 2024, NSSP received data from 78% of US EDs.

| Signal | Description |
|---------------------------------|--------------------------------------------------------------------------------------------------------------------------------------|
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| `smoothed_pct_ed_visits_influenza` | 3 week moving average of `pct_ed_visits_influenza` <br/> **Earliest date available:** 2022-10-01 |
| `smoothed_pct_ed_visits_rsv` | 3 week moving average of `pct_ed_visits_rsv` <br/> **Earliest date available:** 2022-10-01 |
| `smoothed_pct_ed_visits_combined` | 3 week moving average of `pct_ed_visits_combined` <br/> **Earliest date available:** 2022-10-01 |
| `pct_ed_visits_covid_2023RVR` | Percent of ED visits that had a discharge diagnosis code of COVID-19 <br/> **Earliest date available:** 2022-10-01 |
| `pct_ed_visits_influenza_2023RVR` | Percent of ED visits that had a discharge diagnosis code of influenza <br/> **Earliest date available:** 2022-10-01 |
| `pct_ed_visits_rsv_2023RVR` | Percent of ED visits that had a discharge diagnosis code of rsv <br/> **Earliest date available:** 2022-10-01 |
| `pct_ed_visits_combined_2023RVR` | Percent of ED visits that had a discharge diagnosis code of COVID-19, influenza, or rsv <br/> **Earliest date available:** 2022-10-01 |

## Table of Contents
{: .no_toc .text-delta}
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## Estimation

The percent visits signals are calculated as a fraction of visits at facilities reporting to NSSP, rather than all facilities in the area.
County and state level data is reported as-is from NSSP, without modification, while `hrr` and `msa` are estimated by Delphi.
For primary signals, `county`, `state` and `nation` level data is reported as-is from NSSP, without modification, while `hhs`, `hrr` and `msa` are estimated by Delphi.
For secondary signals, `state`, `hhs` and `nation` level data is reported as-is from NSSP, without modification.

### Geographic weighting
As the original data is a percentage and raw case counts are not available, `hrr`,`msa`, and `hhs` values are computed from county-level data using a weighted mean. Each county is assigned a weight equal to its population in the last census (2020). Unreported counties are implicitly treated as having a weight of 0 or a value equal to the group mean.
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